CBCT-Aided Multidisciplinary Approach to Salvaging an Intruded Tooth

Abstract:

Among the most severe types of traumatic dental injuries is intrusive luxation, which displaces the affected tooth deeper into the alveolus, causing significant damage to the pulp and all of the supporting structures. This article describes a unique case of intrusive luxation of the mature left maxillary central incisor in an 18-year-old male patient. The diagnosis was confirmed using cone-beam computed tomography (CBCT), after which the intruded tooth was successfully repositioned by endodontic and orthodontic management. This was followed by prosthodontic rehabilitation. This case report also discusses the role of CBCT in effectively diagnosing this type of injury.

Traumatic intrusive luxation is one of the most severe types of dental injury that commonly affects maxillary incisors.1 Intrusion of a tooth refers to its displacement farther into alveolar bone. Intrusive luxation generally exists in 1.9% of traumatic injuries involving permanent teeth.2 Serious damage to the tooth pulp and supporting structures occurs because of the forced axial dislodgement of the tooth into its socket toward the alveolar bone. The repair process after intrusion can be complex.3 Intrusive luxation can lead to pulp necrosis, external/internal root resorption, loss of marginal bone support, replacement resorption/ankylosis, disturbance in continued root development, partial/total pulp canal obliteration, and gingival recession.4

The management of an intruded permanent tooth may consist of: (1) allowing spontaneous re-eruption; (2) surgical repositioning and fixation; (3) orthodontic repositioning; and (4) a combination of surgical and orthodontic therapy.3 Despite a variety of available treatment modalities, rehabilitation of intruded teeth is quite challenging. The present case report discusses the successful management of an intruded permanent maxillary left central incisor due to traumatic injury.

Case Report

Clinical Examination and Diagnosis

An 18-year-old male patient reported to the authors’ outpatient department following traumatic injury to his teeth caused by a fall during a fight 2 days earlier. Upon clinical examination, several problems were observed, including soft-tissue lacerations on his upper lip, intrusion of the maxillary left central incisor, and a complicated crown fracture involving pulp (Figure 1).There was no color change in the crown of the tooth, which was intact. The intruded teeth showed no mobility. There was no evidence of traumatic injury to any other teeth.

An intraoral periapical radiograph revealed an apically intruded maxillary left central incisor with closed apex (Figure 2). The cemento-enamel junction was located more apically—approximately 3 mm to 4 mm higher in the intruded tooth compared to the adjacent uninjured tooth. A multi-slice cone-beam computed tomography (CBCT) scan (CS 9000, Carestream Dental, www.carestream.com) was performed on the involved tooth as well as the adjacent teeth to confirm the depth of intrusion (Figure 3). All required measures were taken to protect the patient from radiation, including the use of shielding devices such as a leaded thyroid collar for protection of the thyroid gland, leaded glasses to protect the eye lenses, and a leaded apron for protecting the body trunk.

The images were obtained in transverse, axial, and sagittal sections of 0.5-mm thickness. The scanning was done at a tube voltage of 96 Kv, a current of 12 mA, and exposure time of 12 seconds. CBCT scan slices confirmed 3 mm to 4 mm of intrusion of the maxillary left central incisor. The periodontal space surrounding the intruded incisor was diminished.5 There was no sign of external or internal root resorption.